Your HR and Payroll compliance and policy solution! Comply with federal, state, and international laws, find answers to your most challenging questions, get timely updates with email alerts, and more with our suite of products.

Oct. 22 --The federal government
gets $20 back for every dollar invested in False Claims Act health-care fraud
cases, a higher rate than indicated by the Department of Justice's reporting on
FCA settlements, according to a report from the Taxpayers Against Fraud (TAF) Education
Fund released Oct. 22.

The report, “Fighting Medicare & Medicaid
Fraud: The Return on Investment from False Claims Act Partnerships,” said that
the DOJ's reporting doesn't include criminal fines associated with FCA cases or
state recoveries associated with federal FCA cases, which together accounted
for $9 billion in recoveries from fiscal year 2008 through FY 2012.

As a
result, the DOJ's return on investment of 16-to-1 for FCA health-care fraud
cases “is an understatement of the full 'rate of return' from the federal
government's anti-fraud activities,” the report said.

Overall
Recoveries

During the same time frame, the three agencies
that investigate and prosecute health-care fraud FCA cases (the U.S. Attorney's
Offices, the Department of Health and Human Services Office of Inspector
General and the DOJ's Civil Division) received a total of $575 million from the
Medicare trust fund for health-care fraud enforcement, the report said.

“While it is difficult to quantify federal and state costs associated with
recovering these federal criminal and state civil dollars, we are confident
that if all costs and benefits are accounted for, the benefit to cost ratio of
False Claims Act law enforcement now exceeds 20:1,” the report said.

Whistle-Blower Cases

FCA cases involving health-care fraud
whistle-blowers have increased dramatically since 1986, when penalties under
the FCA were strengthened, the report said.

For example, from 1986 to
1992, there were 62 new health-care fraud whistle-blower referrals,
investigations or actions. In comparison, there were 417 in 2011 and 412 in
2012.

In 2012, whistle-blowers received $284 million out of $2.5 billion
in health-care fraud whistle-blower settlements.

The TAF report also
said that criminal FCA cases are becoming increasingly important to the federal
government.

“Not only do they bring in additional recoveries, but also
they create the possibility of criminal conviction, which serves as a deterrent
to committing fraud against the government,” the report said.

Criminal
FCA cases also often are linked with civil FCA cases, the report said, as a
civil investigation can lead to criminal charges.

Congressional
Comment

Sen. Charles E. Grassley (R-Iowa), who wrote the 1986
amendments to the FCA, said the TAF report indicates the value of the FCA.

“The law has empowered whistleblowers to come forward, risk their careers
and root out the shady characters looking to give the taxpayer a bad deal,”
Grassley said in a statement released Oct. 22.

Although the focus in
1986 was on defense contractors, the FCA is “the most effective tool against
health care fraud, as evidenced by the report released today,” he said.

Grassley said any attempts to weaken the FCA “should be met with skepticism
by the courts and Congress.”

To contact the reporter on this
story: James Swann in Washington at jswann1@bna.com

To contact the editor responsible for this story: Ward Pimley at wpimley@bna.com

All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to books@bna.com.

Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)

Notify me when updates are available (No standing order will be created).

This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to research@bna.com.

Put me on standing order

Notify me when new releases are available (no standing order will be created)